The information I have provided is correct to the best of my knowledge and I understand that if I provide any information which is false, you may refuse to consider my application.

I give my permission to the authority that provides my benefit or tax credit to give you any further information to support my application.

I understand that AWIN may occasionally contact me by telephone, email, text or in person to make sure I am given the best support for my needs.

I understand that if my situation changes I can tell Leaf Water and they will change my details or remove me.